Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215349 DEA: 081C0824 EFIS: 0816000087
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R104.9/R134.2
Work Description: PLACE HMA (TYPE A), JPCP AND IMPORTED BORROW.
Location Description: RIVERSIDE COUNTY FROM ROUTE 10/177 SEPARATION TO 1.1 MILES WEST OF WILEY'S WELL RD OC
Contractor Name: FISHER SAND & GRAVEL CO.
Contractor Address: 1302 W DRIVERS WAY, TEMPE, AZ. 85284
Resident Engineer: Khoi Vu Structure Rep.: Shukri Abouazra
DIME Sample ID: 2022-05-10-21
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Blythe Field Testing Laboratory
Sample Organization Contact: 9096015132
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/10/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/12/2022
The quantity of what the sample constitutes: 2 boxes,1 core
A brief description of the sample: 3/4" PG 58-34 #CA140
From where was the sample collected: Manufacturer
Laboratory sample identification: 6A
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fisher Sand and Gravel
DIME Test ID: 2022-05-10-21-1
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Submitted By Organization: CT D08 - Blythe Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: brian.teh@dot.ca.gov
Organization Phone: (909) 601-5132
Data has not been verified.
DIME Test ID: 2022-05-10-21-2
Test Method: AASHTO T275-07r12: Standard Method of Test for Bulk Specific Gravity (Gmb) of Compacted Asphalt Mixtures Using Paraffin-Coated Specimens (Bulk Specific Gravity)
Submitted By Organization: CT D08 - Blythe Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: brian.teh@dot.ca.gov
Organization Phone: (909) 601-5132
Data has not been verified.
